Fibrin Glue Vasectomy Reversal® Patient Guide

Scott & White Results

Dr. Erin T. Bird, Scott & White urologist and section chief for genitourinary reconstruction, uses fibrin glue during the reversal, which reduces operative time and the number of required sutures. Because the procedure requires less time in the operating room, it is considerably less expensive than traditional microsurgery. This surgery is only offered at the Temple, TX location.

If you have questions or comments, feel free to use our online contact form or call Alyssa Anderson at 866-850-4931.

Under most circumstances insurance will not pay for vasectomy reversals performed to restore fertility. As a result, vasectomy reversals are considered elective surgeries and require prepaid arrangements similar to plastic surgery procedures. Most vasectomy reversal centers charge between $7,000 and $10,000 for a comprehensive package. Dr. Bird and Scott & White are able to offer this service at a substantially reduced price. A standard vasectomy reversal, which includes surgeon, anesthesia and facility fees, can be performed for $4,500.

Most patients undergoing vasectomy reversal do not require a vasoepididymostomy (VE). Likewise, most of our patients have declined the option of a VE. For patients who desire the option of a VE, an additional deposit of $1,500 is required. This will be refunded if a VE is not performed. Some couples may elect to have semen collected at the time of surgery and frozen (cryopreservation) — this can be done for a one-time charge. (Yearly storage fees will apply.)

No. While some centers charging in upwards of $8,000 offer a money back guarantee (often a sliding scale of the surgeon's fee only), Scott & White does not. The current package price of $4,500 is similar to the expected residual after refund of the surgeon’s fee in other package prices.

Total operative time is a major determinant of cost. While in the United States Air Force, Dr. Bird and his colleagues developed a novel modification to the standard vasectomy reversal procedure that substantially reduces the total operative time while maintaining good results. These cost savings are being passed on to couples.

Many aspects of the surgery are the same. The procedure is performed under general anesthesia in main operating rooms of Scott & White Hospital. An operating microscope and delicate microsurgical instruments are utilized. The main difference is the use of fibrin glue. With a standard vasectomy, six to 10 sutures are placed–Dr. Bird’s modification requires only three to four. Fibrin glue is then added to seal the anastomosis. This modification was based on animal studies that showed superior results when compared to standard vasectomy reversal. Dr. Bird and his colleagues were the first to report its human application in over 38 initial patients; their results were presented at the 2004 American Urological Association meeting in San Francisco. These results were published in the October 2005 issue (pdf) of the Journal of Urology.

Dr. Bird uses an FDA-approved product for surgical hemostasis (stoppage of bleeding) called Tisseel VH Fibrin Sealant. It has also been used for many years for a variety of procedures–plastics, pediatric, trauma, orthopedics and reconstruction. In more than 20 years of use there have been no cases of Hepatitis A, B or C, or HIV caused by Tisseel. The active components of Tisseel (human fibrinogen and bovine aprotinin) undergo a comprehensive viral inactivation process to ensure safety. Similar to other medical products and devices, allergic reactions are possible, but are very rare.

A standard vasectomy reversal is where the two ends of the vas deferens are microscopically sutured back together and sealed with fibrin glue. Rarely, depending on the time from vasectomy and where on the vas the vasectomy was performed, the fine drainage tubules of the epididymis (the top part of the testicle) can become blocked. There is no way to know for sure prior to surgery. In initial studies, if no sperm was found at the time of vasectomy reversal and a standard reversal process was performed, the success rate was about 50 percent as far as return of sperm in the semen. If optimal results are desired, the patient may elect to undergo a vasoepididymostomy and "bypass" the blockage by making the connection higher up on the epididymis. This takes longer and an additional $1,500 is required if this option is desired. Again, most couples will not require this.

If the patient is over 15 years out from the vasectomy, the chances of needing a VE are considerably higher (about 10 percent to 30 percent). Each couple will need to make this decision ahead of time but most couples elect to have the standard reversal alone. Additional factors may be discovered during the physical examination that will influence the outcome of the procedure (for example, the farther away from the testicle the vas site is, the more favorable the results).

Ultimately, the goal is for couples to experience a pregnancy(s) through natural conception. Patients remote from vasectomy (over 10 to 15 years) and spouses with advanced maternal age may require assisted reproductive technology that is not included in the package. View the results of Scott & White's vasectomy reversals (pdf) sorted by years out from vasectomy.

After the procedure is performed, patients are asked to provide a semen analysis every three months until a pregnancy is achieved. This analysis will allow the patient and Dr. Bird to see the results of the procedure. The fee for this analysis is not included in the package price and it is up to the patient to schedule this. If the patient chooses to have this analysis done at the Scott & White Andrology Lab, contact the Scott & White Urology department for a lab request and instructions. If the patient chooses another facility to have the analysis done, Dr. Bird’s office will fax a lab request to the facility, if necessary. Please provide Dr. Bird’s office with the facility name, phone and fax numbers. Patients may also be asked to participate in follow-up studies for publication. Patient participation is appreciated, but certainly not required.

With a vasectomy reversal, patients will most likely experience more pain and swelling compared to their vasectomy–the degree of pain would be similar to hernia surgery. Depending on individual patient anatomy, one or two incisions (one to three inch inches long) will be made. A clear piece of plastic gauze will cover the scrotum and should be left on for at least three days. Blood staining on the gauze is normal and expected. An ice pack should also be applied to the scrotum for the first 12 hours (20 to 30 minutes on; 20 to 30 minutes off). Patients may shower after two to three days. Tub baths are not allowed until the incision has completely healed and hot tub baths are prohibited until a pregnancy is achieved. Patients will be prescribed pain medication and antibiotics will be administered at the time of surgery. Generally, none are needed afterward. Occasionally, the incision can separate. This is usually not a problem and the skin will heal without intervention, although it might have a bit of an exudate (yellowish fluid) until it does. Notify Dr. Bird or the urologist on call if there is increasing redness around the incision, progressive swelling, fever or for other emergent concerns.

Dr. Bird wants the patient to refrain from strenuous activity (running, jogging, biking, etc.) and any heavy lifting (anything over 30 pounds) for 4 weeks following the procedure. The patient should also refrain from intercourse/ejaculations for 3 weeks following the procedure.

To schedule an appointment some demographic information will be collected from patients. The patient’s full name, date of birth, social security number, address, two contact phone numbers, occupation and marital status must be provided. Patients will also be asked how long ago their vasectomy procedure was performed. We will also need to have a credit card to hold on file for the cancellation/rescheduling fee mentioned in the payment section below. Once all of the information is collected, an appointment can be scheduled.

There are two options for scheduling with Dr. Bird. Please let us know which option you choose at the time of your call.

Option #1: Come in for a consultation visit with Dr. Bird and schedule the surgery at a later date. The cost for the consultation is $300 and will need to be paid at the time of check-in for the appointment. If the patient decides to schedule the surgery for later in the future the $300 fee will be deducted from the amount of the surgery, since it has already been paid.

Option #2: Select a surgery date from the available dates on Dr. Bird’s schedule and come in the afternoon before for the preoperative appointments. There are three mandatory preoperative appointments that the patient will need to attend prior to the procedure.

Dr. Bird to discuss the procedure and sign the consents

Business office to make the full payment

Anesthesia/day surgery assessment

Patients who are over 50 or have other health problems such as heart disease, lung disease, high blood pressure or diabetes will need to come with a note of clearance from their primary care provider. Patients must be off Aspirin, Motrin or any blood thinners 10 days before their procedure.

If the patient wants to save sperm (cryopreservation), he will also need to meet with the andrology department. If sperm cryopreservation is desired, the patient must inform Scott & White prior to the procedure so it can be added to his schedule. Additional fees apply.

The surgery dates for Dr. Bird vary with each month and are on a "first come, first serve” basis. Dates that are available fill up quickly, and patients are urged to contact the office immediately once they have worked out a day that will work with their schedule.

For all questions regarding payment, please contact the Business Office at 254-724-6935 or 1-800-792-3710, extension 6935. This office handles all of the payments for the procedure. Payment must be made in full before the procedure can be performed. Our representative will explain the payment options.

A $300 cancellation fee will be billed to the patient if a scheduled procedure is canceled without rescheduling, canceled or rescheduled within 10 days of the scheduled procedure, or if a patient does not show for the scheduled preoperative appointments and/or procedure.

Fibrin Glue Vasectomy Reversal is a registered trademark. Unauthorized use is prohibited.